Journal of Clinical Case Reports

ISSN: 2165-7920

Open Access

Current Issue

Volume 11, Issue 3 (2021)

    Case Report Pages: 1 - 3

    Impact of Graded Early Mobilization Therapy on Psychomotor status of a Patient who was Mechanical Ventilated in Intensive Care Unit: A Single Case Report

    Bijoy Das

    The purpose of the study was to explore the impact of graded early mobilization on psychomotor status of patients with mechanical ventilation. To measure the effect of early mobilization on days first out of bed, other motor function, psychological status and length of ICU stay of mechanically ventilated patient. This was a single case study. Sample was selected from BRB Hospitals Limited of Dhaka using convenient sampling method and according to selection criteria. A precise semi structured questionnaire was used for data collection. Graded early Mobilization was provided as intervention to the participant by a Professional qualified Physiotherapist for 10 sessions. Another Senior Physiotherapist was assigned as data collector. He assessed the participant’s Functional Independence Measure (FIM) score and Generalized Anxiety Disorder 7 point (GAD-7) score during discharge from ICU. It was found that Functional Independence Measure (FIM) score was 65 which means the participant was very much independent during discharge from ICU. The finding of GAD-7 was 04, which indicates that the participant was free from any psychological problems. This study showed that graded early mobilization was effective to improve mechanically ventilated patients motor and psychological status.

    Short Communication Pages: 1 - 2

    A Single Centre Based Study on Prevalence of Left Ventricular Dysfunction in End Stage Renal Disease Patients on Peritoneal Dialysis

    Dr. Richu Sharma* and Shivali Sharma

    Heart failure affects more than 40 million people globally in a single year and is expected to increase in the coming time. In patients, who have associated co-morbidities are more likely to develop left ventricular dysfunction and subsequently heart failure. Left ventricular dysfunction increases cardiovascular mortality and morbidity in end stage renal disease patients on hemodialysis. Peritoneal dialysis has emerged as an alternative mode of renal replacement therapy for end stage renal disease patients. However the prevalence of left ventricular dysfunction in end stage renal disease patients is scarcely known. A 33.33% prevalence of left ventricular dysfunction has been observed in our study.

    Case Report Pages: 1 - 2

    Acute Pancreatitis-Rare Complication of Falciparum Malaria

    Satya Kant Tiwari* and Richa Patel

    A 26-yr old army man of commandant rank posted in forest belt of district Mirzapur Uttarpradesh, presented to the medicine emergency department with a 4-day history of high grade fever which was associated with chills and rigor, vomiting and generalized abdominal pain. Peripheral blood smear stained with leishman demonstrated ring-form trophozoites of P. falciparum with high parasitaemia (62%) with rapid antigen test for P. falciparum was also positive. Chest X-ray was normal. Non contrast computed tomography (CT) scan of the abdomen showing a bulky pancreas with peripancreatic fat stranding suggestive of acute pancreatitis. A diagnosis of severe falciparum malaria with acute pancreatitis was made on basis of investigation. Treatment in form of intravenous quinine 1000 mg as loading dose in 10% dextrose solution followed by 500 mg in same solution and was monitored for hypoglycaemia. Oral quinine tab was started 8th day up to 15th day. The patient was discharged on 18th day and his condition was good on further follow up.

    Case Report Pages: 1 - 5

    A Case Report of an Unusual Presentation of Melioidosis

    Phani Machiraju*, Rama Narasimhan, Kiran Kompella and Suresh Kumar D

    Melioidosis is a granulomatous infectious disease caused by Burkholderia pseudomallei. It is a motile, aerobic, oxidase-positive, gramnegative,
    non-spore forming soil saprophyte. It has gained a lot of importance in recent times as one of the most potent emerging
    infections in India. The clinical presentation of Melioidosis is highly variable, ranging from benign skin and soft tissue infections to rapidly
    fulminant and fatal septicaemia. It is because of this wide range of clinical diversity, it is called "Great mimicker" and poses diagnostic
    challenges to clinicians. In this case report, we illustrate the diagnostic difficulties we faced and our management of infrequent complication
    of disseminated Melioidosis presenting as broncho-oesophageal fistula with concomitant lung consolidation.

    Case Report Pages: 1 - 3

    Metastatic Disease to the Pancreas from Squamous Cell Lung Cancer: A Case Report

    Ivan Bivolarski*

    We present a one clinical case of patient with metastasis of squamous cell non–small-cell lung cancer in pancreas. A 49-year-old Caucasian male patient presented to our Medical Oncology department with obstructive jaundice and severe abdominal pain, after the last course of chemotharapy. Six months prior to presentation the patient had undergone right bronchoscopy, due to stage IV, moderate-grade squamous cell lung carcinoma. After the bronchoscopy, the patient receives chemotherapy and radiotherapy. Abdominal computed tomography on admission after the last course of chemotharpy, revealed lesion located at the head of the pancreas, causing biliary obstruction. The abdominal computer tomography reveals also lesion in left adrenal gland. Histological examination reveals and changes in grade of the histology from moderate in primary foci in lung to low-grade in metastasis in pancreas. Due to the severe pain in the abdomen and jaudice of the metastatic disease, surgical resection was proposed and the patient underwent pancreaticoduodenectomy. Histological examination of the resected specimen from pancreas confirmed a low-grade squamous cell carcinoma form the lung.

    Case Report Pages: 1 - 3

    Fibroadenoma of the Breast in Identical Twin: A Case Report

    Marwa Badawi* and Ahmed Shalaby

    Fibroadenoma is a painless, unilateral, benign breast lesion that is a solid in consistency. It occurs most commonly in women between the age of 14 to 35 years but can be found at any age. This is a case report for a young twin who presented to the one stop clinic with a unilateral breast lump in the right upper quadrant of the breast. Both patients were assessed clinically by obtaining detailed history and clinical examination and further evaluation of the lump was done by ultrasound examination, which confirmed diagnosis and patients were reassured and treated conservatively.

    Case Report Pages: 1 - 2

    Papilledema and Diplopia Due to Meningioma Inside the Superior Sagital Sinus: Case Report and Review of the Literature

    Marta Rico Pereira* and Carlos Asencio Cortés

    Small lesions invading or compressing dural sinuses are frequent but secondary intracranial hypertension is not very common, with few examples reported in the literature. This event may be explained in the setting of anatomic variants in pattern of venous sinus circulation. We present the case of a patient who presented with papilledema and loss of visual acuity due to a small meningioma located inside the superior sagittal sinus (SSS). The patient underwent a lumboperitoneal shunt placement with recovery of symptoms. Literature available is also reviewed.

    Review Article Pages: 1 - 2

    Impact of Graded Early Mobilization Therapy on Psychomotor Status of a Patient Who was Mechanical Ventilated in Intensive Care Unit

    Bijoy Das*, Sanchita Saha, Feroz Kabir and Sazzad Hossain

    Purpose: The purpose of the study was to explore the impact of graded early mobilization on psychomotor status of patients with mechanical ventilation.

    Objectives: To measure the effect of early mobilization on days first out of bed, other motor function, psychological status and length of ICU stay of mechanically ventilated patient.

    Methodology: This was a single case study. Sample was selected from BRB Hospitals Limited of Dhaka using convenient sampling method and according to selection criteria. A precise semi structured questionnaire was used for data collection.

    Graded early mobilization was provided as intervention to the participant by a Professional qualified physiotherapist for 10 sessions. Another senior physiotherapist was assigned as data collector. He assessed the participant’s Functional Independence Measure (FIM) score and Generalized Anxiety Disorder 7 point (GAD-7) score during discharge from ICU.

    Results: It was found that Functional Independence Measure (FIM) score was 65 which means the participant was very much independent during discharge from ICU. The finding of GAD-7 was 04, which indicates that the participant was free from any psychological problems.

    Conclusion: This study showed that graded early mobilization was effective to improve mechanically ventilated patients motor and psychological status.

    Case Report Pages: 1 - 3

    Rare Gingival Metastasis by Pancreatic Carcinoma: A Case Report

    Gordana Zamolo*

    Metastatic tumors to oral cavity are rare and represent approximately 1% off all cases of oral malignat lesions even though metastatic disease may be present. The 53-year-old female presented in March of 2017 complaining with abdominal pain, weight loss and loose stool not more than 3 times per day. CT scan of the abdomen in July showed retroperitoneal mass expanding along the body of the pancreas. Colonoscopy and gastroscopy with biopsy of mucosa of the stomach showed normal result. The tumor marker Ca 19-9 in July 2018 was 110.3 and in August 2018 350.6. The patient was referred in September of 2018 to the maxillofacial surgery Clinic for examination of the lesion in the oral cavity. She presented with a pain, swelling and occasional bleeding around the lower right second mollar. Immunohistochemical the tumor cells were positive for Cytokeratin (CK) 19, Cytokeratin (CK) 7, and homebox protein (CDX-2) which is highly sensitive markers of pancreatobiliar cancer. Therefore, the patient was diagnosed with pancreatic carcinoma. This report describes a rare metastasis of malignant pancreatic tumor in lower right gingiva and highlights the importance how immunohistochemical examination ped to identify both the origin and the nature of gingival neoplasm.

    Case Report Pages: 1 - 2

    Purpura Fulminans in a 9-Year-Old Boy with Auto-Amputation of Digits: A Case Report

    Naheed Maqbool*, Rabbia Khurshid, Saleem Ullah Khan and Noor Us Sabah

    Purpura fulminans may have infectious, hereditary and idiopathic etiology. We came across a case of purpura fulminans in a 9-year-old boy who
    had been healthy for first 4 years of his life and suddenly developed gangrenous lesions on extremities which proceeded to the detachment of
    some digits. Laboratory evaluation revealed mild anemia, hypoalbuminemia, high platelet count, elevated aPTT, PT and INR, mild proteinuria and
    high urinary protein to creatinine ratio. Child was managed by warfarin therapy.

    Case Report Pages: 1 - 5

    Research Progress of Novel Coronavirus Pneumonia Vaccine

    Song Peng*

    Since novel coronavirus pneumonia (novel coronavirus pneumonia) novel coronavirus outbreak, countries around the world have accelerated the development of a new coronavirus pneumonia vaccine (new crown vaccine). As of December 2020, 60 candidate new coronal vaccines have been approved for clinical trials, among which 7 vaccines (3 inactivated vaccines, 2 mRNA nucleic acid vaccines, and 2 vector vaccines) have been approved for emergency use or conditional marketing. In this paper, the development progress, advantages, and disadvantages of six new coronal vaccines including inactivated vaccine, nucleic acid vaccine, vector vaccine, protein subunit vaccine, live attenuated vaccine and virus-like particle vaccine was reviewed. The results of the novel coronavirus pneumonia in phase III clinical trials show that the new vaccine has good safety and immunogenicity. The approved vaccine has been proved to have good protective efficacy. However, attention should be paid to the adverse reactions of the vaccine and the long-term protective effect.

    Case Report Pages: 1 - 2

    Mixed Adenoneuroendocrine Carcinoma of the Perianal Region: A Case Report

    Jelena Berendika, Gordan Nikic*, Dejan Dokanovic, Milka Vjestica, Sanja Savic, Sasa Jungic, Zdenka Gojkovic, Bozana Babic and Biljana Tubic

    Paraganglioma is a very rare extra adrenal nonepithelial tumor. The number of cases of laparoscopic surgery in Paraganglioma is small and controversial. This study encountered a case of successful transperitoneal laparoscopic surgery for a 56 mm paraganglioma in a 53-year-old female. Moreover, previous reports on laparoscopic surgery for paraganglioma are reviewed.

    Case Report Pages: 1 - 6

    A Patient with Paraganglioma Undergoing Laparoscopic Resection: A Case Report

    Hisamichi Yoshii*, Hideki Izumi, Takuma Tajiri, Masaya Mukai, Eiji Nomura and Hiroyasu Makuuchi

    Paraganglioma is a very rare extra adrenal nonepithelial tumor. The number of cases of laparoscopic surgery in Paraganglioma is small and controversial. This study encountered a case of successful transperitoneal laparoscopic surgery for a 56 mm paraganglioma in a 53-year-old female. Moreover, previous reports on laparoscopic surgery for paraganglioma are reviewed.

    Case Report Pages: 1 - 3

    Alignment of Buccally Erupted Canine Using HANT Wire

    Parijat Chakraborty*, Kamlesh Singh, Ragni Tandon, Richa Dhingra and Pranshu Mathur

    Ectopic teeth develop when displaced from their normal position. Any permanent tooth can be ectopic, and the cause may be both genetic and environmental. Orthodontic treatment is justifiable for aesthetic reasons. Subsequently a careful diagnosis along with a proper treatment plan for ectopically erupting permanent maxillary canines requires timely management by the orthodontist. The purpose of this case report is to illustrate
    an approach involving management using HANT wire.

    Case Report Pages: 1 - 2

    Severe COVID-19 with 32 Weeks of Pregnancy Treated by Convalescent Plasma: A Case Report

    Ashraful Hoque*

    Pregnant women with coronavirus disease 2019 (COVID-19) show overall similar clinical features as that of non-pregnant adults with COVID-19, except perhaps for higher risk of admission to the Intensive Care Unit (ICU) and mechanical ventilation. Apart from the established therapeutic options used in COVID-19 like steroid, low molecular weight heparin role of COVID Convalescent Plasma (CCP) has never been evaluated. We present a case of a pregnant woman, treated with CP at the AMZ hospital, Dhaka, Bangladesh.

    Case Report Pages: 1 - 2

    Thyrotoxic Hypokalemic Periodic Paralysis: A Case Report

    Ketlin Batista de Morais Mendes, Cristhenise Ragnini Silva*, Bárbara Silvestre Vicentim, Thaís Rockenbach Gaona Lenzi, Gabriela Moreira Ferle, Vanessa Almeida Santos, Wülgner Farias da Silva, André Nazário de Oliveira and Antonio Solon Mendes Pereira

    Periodic Thyrotoxic Hypokalemic Paralysis (PTHP) is a rare endocrinological complication characterized by hypokalemia, episodes of muscle weakness and thyrotoxic symptoms. The following is a case report of PHHP in a black patient diagnosed with hyperthyroidism during an episode of sudden and progressive weakness associated with hypokalemia. PHHP is often underdiagnosed and should be remembered as a diagnosis of acute muscle weakness in young patients, especially males, regardless of ethnicity, although it is frequent in Asians.

    Case Report Pages: 1 - 3

    A Case Report of Aortic Dissection in A Uremic Hemodialysis Patient

    Zhi Xiao*, Binbin Wang and Yanyu Li

    Aortic dissection is a critical cardiovascular disease with extremely high mortality. It has an acute onset and poor prognosis. Patients with uremic
    hemodialysis have more risk factors for aortic dissection than ordinary patients. Early diagnosis and treatment have a positive impact on the
    prognosis of aortic dissection. This article reports a case of uremic hemodialysis complicated with aortic dissection, aiming to further explore the
    clinical diagnosis, treatment and distinguishing characteristics of uremic complicated with aortic dissection, and improve the early diagnosis rate
    of the disease.

    Review Pages: 1 - 7

    Recurrent Venous Thrombosis and Breakthrough Thrombosis: A Narrative Review

    Rasha A. Al-Khafaji*

    Venous Thromboembolism (VTE) is a vexing heterogeneous disease that, along with Myocardial Infarction (MI) and stroke, is among the top three cardiovascular killers. VTE's morbidity and mortality globally cause high social, health, and economic impacts. The modern diagnostic strategies of Deep Venous Thrombosis (DVT) and Pulmonary Embolism (PE) developed to aid physicians in diagnosing these presentations and using imaging resources effectively have shown limitations in several subgroups, including patients with recurrent VTE or those who are already on anticoagulation therapy. In the light of a previously reported breakthrough (recurrent) DVT while on rivaroxaban 20 mg PO daily in a 43-year-old Caucasian female, this review discusses the various etiologies, which contribute to anticoagulant's failure and VTE's recurrences in general to increase awareness among practicing physicians about these subgroups. The roles of imaging and D-dimer testing in these subgroups are also discussed, leading the author to cautiously conclude that diagnostic imaging plays a central role in identifying recurrence regardless of D-dimer testing and recommending baseline sonography upon completing DVT anticoagulation therapy for future references. Accurate diagnostic strategies are needed to ensure the best available care and treatment reaches the patient. Based on this review, the author constructs a hypothetical algorithm targeted to diagnose recurrent VTE or breakthrough VTE while on anticoagulants coupled with the possible causes for recurrent and breakthrough VTE. This algorithm should only be considered as hypothesis-generating for specifically designed prospective studies to assess and validate the algorithm's potential in decreasing the incidence of missed diagnosis of VTE and their underlying etiologies in these subgroups.

    Case Report Pages: 1 - 2

    A Curious Case of Hypertensive Emergency and Acute Kidney Injury

    Oluwaseun Oluwo*, Dennis Hu, Ashkan Karimi, Garland Campbell and Negiin Pourafshar

    A 75-year-old female with history of a prior right renal artery stent (coronary bare metal stent, duration 3 years), stage IV CKD (baseline serum creatinine (Scr) 2.1-2.3 mg/dL (eGFR 20-23 ml/min/1.73 m2)), diastolic heart failure, and hypertension. She had multiple hospital admissions for acute decompensated heart failure, now presenting with worsening dyspnea, increased oxygen requirements of 4 L oxygen via nasal canula, increased from baseline 2 L. Despite treatment with up to nine anti-hypertensive medications, her systolic BP remained 180-200 mmHg. Her Scr also increased to 3.92. Work-up showed normal kidney sizes and urine protein/creatinine ratio 1.26 g/g. Renal artery duplex revealed right renalartery peak systolic velocity 267 cm/sec, renal-to-aortic ratio 2.68, and resistive index 0.7-0.9, suggestive of right renal artery re-stenosis and some intrinsic damage. Due to progressive volume overload and worsening respiratory status, she required temporary hemodialysis. As her volume status improved, she underwent CO2 angiogram and was found to have 90% diffuse in-stent restenosis with marked deformity of the previous stent. She underwent re-stenting of the right renal artery with a proprietary FDA-approved Herculink Elite® renal stent with only 8 ml of contrast. Immediately post-intervention, her BP dramatically improved and after two months, hemodialysis was stopped, (new baseline SCr 1.5-1.9) and she only required two BP medications.

    Case Reports Pages: 1 - 3

    Acute Kidney Injury Related to Muscle Breakdown-Not All Due to Rhabdomyolysis: A Case of Acute Urate Nephropathy

    Oluwaseun Oluwo*, Anita Vincent-Johnson and Kambiz Kalantari

    A young man with a history of pseudo-seizures was admitted after an episode of severe agitation and rigorous physical activity. The patient was febrile on admission with notable leukocytosis and lactic acidosis but a negative infectious workup. During the hospitalization, the patient developed severe Acute Kidney Injury (AKI) despite fluid hydration. Creatinine Phosphoryl Kinase (CPK) was minimally elevated at 693 U/l. Urine
    microscopy was significant for many uric acid crystals. Subsequent lab studies revealed an elevated uric acid level of 13.4 mg/dl with fractional excretion of urate (Fe-Urate) of 13%. The patient was treated with rasburicase and allopurinol with the improvement of AKI that paralleled the improvement in hyperuricemia. AKI was likely due to acute urate nephropathy from a pseudo-seizure. AKI following an icteric activity or rigorous physical activity can occur via a mechanism that is independent of rhabdomyolysis. Acute Urate Nephropathy should be considered in cases with no significant elevations of CPK, with prompt initiation of rasburicase and potentially rapid resolution of AKI.

    Case Report Pages: 1 - 3

    Thinking of Rare Bleeding Disorders in the Emergency Room: A Diagnosis of Glanzmann Thrombasthenia in a Pakistani Child

    Salma Mainosh, Ayesha Akbar Khalid*, Mushtaq Ahmed and Syeda Shaheera Hashmi Riaz

    Introduction: Glanzmann thrombasthenia is a rare inherited bleeding disorder, with a global prevalence of about one in one million. It is an autosomal recessive condition characterised by episodes of mucocutaneous bleeding. A defect in the membrane protein results in a defective platelet aggregation.

    Case presentation: A fifteen-month-old female child presented to the emergency department with nosebleed for the last two days. The patient had two similar episodes of epistaxis in previous few months which were managed at home. There was an accompanying complaint of easy bruising since birth. After emergency management and anterior nasal packing, extensive blood tests were ordered to determine the cause for recurrent haemorrhages. Platelet aggregation study concluded a diagnosis of Glanzmann thrombasthenia and the patient was treated accordingly. Family members were thoroughly counselled, and safety netting was vigilantly done.

    Conclusion: Many public tertiary cares set ups in Pakistan lack the adequate diagnostic and therapeutic facilities for bleeding disorders. This does not only result in delaying appropriate care but also causes patients to remain undetected. Through this report, we aim to encourage emergency physicians to have a high index of suspicion for haematological disorders in patients presenting early in life with recurrent bleeding episodes.

    Case Report Pages: 1 - 4

    Balancing Sleep and Motor Symptoms: A Case Report of Managing Insomnia in Parkinson's Disease

    Meghan Ha, Nishita S. Amin, Katie Meyers, Jacques Turgeon and Chandni Bardolia*

    Objective: The management of insomnia presents as a challenge for many Parkinson’s disease patients and their care teams. Insomnia in patients with Parkinson’s disease may be attributed to the side effect profile of several medications that are commonly used to treat Parkinson’s disease. Additionally, the progression of the disease is associated with disruption of circadian rhythms, nocturnal symptoms, blunted melatonin secretion, and late melatonin onset. This case report aims to demonstrate how a patient's Parkinson's medication profile could be optimized to control motor symptoms and reduce the occurrence of insomnia through the use of comprehensive medication review services.

    Case report: A 71-year-old male with Parkinson’s disease was developing severe symptoms of tardive dyskinesia due to his chronic carbidopa/levodopa/entacapone therapy. In order to address the tardive dyskinesia, entacapone was discontinued and amantadine was initiated to offset the stiffness and bradykinesia. The addition of amantadine resulted in nightmares and poor sleep quality, even though the patient was already taking mirtazapine to treat his depressive status and insomnia. The patient’s healthcare team collaborated with a clinical pharmacist to adjust the Parkinson’s disease regimen and mirtazapine dosage, all of which resulted in notable improvements in his reported insomnia and quality of life.

    Discussion and Conclusion: Optimizing motor control in patients with Parkinson’s disease, while mitigating insomnia side effects of medications can be a very complex process. The main goal for patients who encounter this problem is to enhance their Parkinson's disease therapy by identifying medications that can contribute to insomnia while addressing the patient's symptoms and disease progression. Alternative treatments to manage insomnia in patients with Parkinson’s disease should also be considered, including the addition of melatonin and/or the use of bright light therapy.

    Volume 11, Issue 4 (2021)

      Case Report Pages: 1 - 3

      Coronary Sinus Ostium Atresia Associated with Direct Connection to the Superior Vena Cava by a Bridging Vein: A Case Report

      Laxman Gyawali*

      Coronary sinus ostial atresia is a rare encounter in the intervention laboratory and is often linked with several congenital cardiac anomalies such as persistent left superior vena cava among others. Over the course of Cardiac Resynchronization Therapy (CRT), our case had the coronary sinus directly communicating with the superior vena cava through an anomalous bridging vein in the absence of a persistent left superior vena cava, along with an atretic right atrial ostium. Also, of interest was the minimal amount of technical challenge offered by such an anomaly for CRT lead implantation provided an otherwise favorable coronary anatomy.

      Case Report Pages: 1 - 5

      Degenerative Disc Disease Reversal: Rethinking Human Physiology

      Dieter Matthias Meier*

      Background: It is recognized in the medical community the world over that intervertebral disc tissue degenerates over the course of life and cannot be regenerated endogenously. But as all living tissue, intervertebral disc cells should be able to absorb and metabolize nutrients and replicate, thereby enabling regeneration. By this logic, disc regeneration should be possible by improving nutrient absorption, which is dependent on correct biomechanics. The role of the autonomic nervous system is critical in understanding function of tissue, including intervertebral discs.

      Case report: In this case study, a man 45-year of age with disc degeneration of the lower lumbar spine between L5 and S1 and pain during exercise was treated with a series of full spine chiropractic adjustments in order to correct biomechanics and improve nutrient absorption of the intervertebral discs. This resulted in the growth of the degenerated disc, which increased the lateral angle between L5 and S1 by 80% coinciding with freedom of pain, free range of motion and an improvement of autonomic balance. This was documented by full spine X-rays and a pre- and post-scan of the autonomic nervous system.

      Conclusion: This study shows that growth of intervertebral disc tissue is possible without the use of medication, surgery or cell transplantation and should be the beginning of rethinking functional physiology and the importance of translational medicine.

      Case Report Pages: 1 - 2

      Right Ovarian Vein Thrombophlebitis Complicated by an Inferior Endocaval Floating Thrombus Revealed by Postpartum Pyrexia: A Case Report

      Faidherbe Clement*

      The clinical course of our patient highlights an atypical presentation of thromboembolic disease related to pregnancy, a thrombophlebitis of the right ovarian vein with endocaval floating thrombus. The diagnosis remains difficult since it is a rare entity with an atypical presentation but with serious medical consequences.

      Case Report Pages: 1 - 5

      Conversion Therapy for Advanced Gastric Cancer with Apa-tinib Combined with SOX Regimen: A Report of Two Cases and Literature Review

      Jun Zhang, Yan Dai and Zhongliang Ning*

      In late state gastric cancer, combination chemotherapy with targeted therapy has been employed, which may control the tumor growth and recurrence. We here report two patients diagnosed with advanced gastric cancer which were treated with SOX regimen combined with apatinib for conversion therapy. After three cycles of this combination treatment, the lymph node metastases and tumor decreased in size, which enabled the surgery (R0 resection), with no recurrence for more than 1 year. We believe that apatinib combined with SOX regimen can increase the possibility of successful surgical resection, and thereby prolonging the progression-free survival of patients with advanced gastric cancer

      Case Report Pages: 1 - 3

      Surgical Management and Outcome of a Ruptured Aseptic Mycotic Cerebral Aneurysm: A Case Report

      Sara M. Zorawski*, Daniel Dubinski, Daniel Cantré, Christian Henker, Andreas Erbersdobler, Florian Gessler, Thomas M. Freiman and Sae-Yeon Won

      Background: Mycotic aneurysms are a rare subset of intracranial aneurysms caused by bacterial, viral or fungal sources. Rupture of an intracranial mycotic aneurysm is a life-threatening event untreated with a mortality range up to 80%.

      Case description: Here, we report the case of a 21-year-old second year female medical student who suffered from a ruptured mycotic aneurysm of the middle cerebral artery with subarachnoid haemorrhage. After surgical resection of the aneurysm, intensive monitoring and treatment of cerebral vasospasm were performed. Further diagnostics for the focus of infection, including laboratory parameters, transoesophageal echocardiography and otolaryngoscopic diagnostic, showed normal findings without any sign of endocarditis, vasculitis or otolaryngitis. After 3 weeks, the patient was discharged in a very well condition.

      Conclusion: Aseptic mycotic aneurysm is a rare subtype with posing significant therapeutic challenge. Surgical resection of those aneurysms might be safe and effective treatment

      Case Report Pages: 1 - 3

      Painful Leg Moving Toes Syndrome: A Report of Two Cases and Update of Clinical Manifestation, Pathophysiology and Management

      Samih Badarny*, Yazid Badarny, Kamal Hassan and Adnan Zaina

      Introduction: Painful Leg and Moving Toes (PLMT) is a rare disorder of unknown etiology. It is characterized by pain and abnormal movement of toes. These symptoms are troublesome to patients but not life-threatening. There is no curative treatment; however, supportive therapy and symptomatic therapy somewhat ameliorate the conditions. Thus, also to avoid extensive or invasive examinations, physicians should be aware this condition.

      Case presentation: The first patient had sensory symptoms that began in both legs, and gradually involuntary movements appeared in the toes of one leg, which spread to the other leg. The second had no leg pain, but involuntary movement of the toes was the sole clinical presentation. Diagnosing these conditions as PLMT, we prescribed pregabalin, clonazepam, baclofen, local corticosteroid injections, epidural blocks and warmwater soaks, which led to partial improvement of these symptoms.

      Conclusion: PLMT presents in different forms, symptoms usually do not worsen over time and not life-threatening, and thus, in this sense, benign condition. We, presenting these two cases, wish to update the clinical presentation, electrophysiological findings, pathophysiology, associated diseases, treatment and management of PLMT

      Volume 11, Issue 5 (2021)

        Case Report Pages: 1 - 4

        Sacubitril/Valsartan for Heart Failure in Patients with Becker Muscular Dystrophy and Dilated Cardiomyopathy: A Case Series

        Maria Vittoria Matassini*, Michela Coccia, Michela Aringolo, Matilda Shkoza, Francesca Lupidi, Mauro Silvestrini, Maria Gabriella Ceravolo, Marco Marini and Gian Piero Perna

        Background: Dilated cardiomyopathy with heart failure is a common cause of morbidity and mortality in patients with Becker muscular dystrophy. An early diagnosis, treatment and a close follow-up are crucial in improving quality of life and prognosis. Neuro-hormonal therapy may improve symptoms and cardiac dysfunction and reduce mortality risk. Little is known about the use of sacubitril/valsartan for heart failure in patients with Becker muscular dystrophy and dilated cardiomyopathy.
        Methods: We present a case series of four patients with Becker muscular dystrophy cardiomyopathy followed in a dedicated cardiologic neuromuscular program and treated with sacubitril/valsartan because of severe left ventricular dysfunction with heart failure symptoms.
        Results: In our experience sacubitril/valsartan was effective in improving symptoms and functional capacity, in reducing hospital admission for HF and, when early introduced, it promoted positive reverse heart remodeling. Despite a fragile population, sacubitril/valsartan was safe, without episodes of hypotension or renal function worsening.
        Conclusion: Sacubitril/valsartan may be considered an effective and safe pharmacological option in patients with Becker muscular dystrophy and dilated cardiomyopathy with reduced ejection fraction.

        Case Report Pages: 1 - 3

        Combined Therapy with New Triazole Agent (Isovocunazole) and Micafungin in Invasive Pulmonary Aspergillosis Complicated by Hemoptysis in Immunocompetent Patient

        Michele Gambardella*, Antonino Crocamo, Vincenzo Barlotti, Augusto La Penna and Gerarda Pirofalo

        Apergillosis in immunocompetent critical patients has increased incidence over the past two decades. Patients at risk include those with systemic steroid therapies and deteriorate pulmonary functions (COPD). Hemoptysis is a devastating complication of pulmonary aspergillosis reported in 28.9% of cases.

        Case Report Pages: 1 - 4

        Post-COVID-19 Multisystem Inflammatory Syndrome in a Young Adult: A Case Report

        Dichtwald Sara*, Paz Yoav, Dana Elad, Fredman Brian and Chowers Michal

        Background: Post-COVID-19 infection syndrome has been described in children, known as Multisystem Inflammatory Syndrome in Children temporally associated with SARS-CoV-2. Clinical signs and symptoms include conjunctivitis, rash, fever, hypotension, gastrointestinal symptoms, myocarditis and coronary abnormalities. Most case reports were described in children, and there are very few case reports of Post-COVID-19 Multisystem Inflammatory Syndrome in Adults (MIS-A). Case report: We describe a case of a healthy 21-years-old man with symptoms of fever, myalgia and loss of taste, followed by severe dyspnea and hypoxemia. Chest computed tomography scan revealed extensive bilateral lung infiltrates. Shock and acute kidney injury followed. Echocardiography showed severe left ventricular dysfunction. The patient was intubated and ventilated. Due to cardiogenic shock and hypoxemia, veno-arterial Extracorporeal Membrane Oxygenation (ECMO) therapy was initiated. A diagnosis of multisystem inflammatory syndrome due to past COVID infection was made. The patient received methylprednisolone pulse therapy and intravenous immunoglobulin therapy. His condition improved quickly, and the patient was weaned off ECMO support. Conclusion: We presented a case of severe MIS-A in a young adult, with recent asymptomatic COVID-19 infection, manifested as cardiogenic shock and pulmonary edema. As MIS-A presentation may mimic other pathologic conditions; high index of suspicion is required.

        Case Report Pages: 1 - 3

        Co-Existence of Pineal Germinoma and Quasi-Moyamoya Disease: A Case Report and Review of Literature

        Rida Mitha*

        Background: The coincidence of Moyamoya along with pineal germinoma is not reported in the literature.
        Case description: We report an unusual presentation of a 19-year-old young man diagnosed with pineal gland germinoma and Moyamoya syndrome. He presented with Parinaud’s syndrome, with radiological investigations (CT and MRI scans) showing pineal gland enhancing lesion causing obstructive hydrocephalus. Endoscopic third ventriculostomy along with lesion debulking yielded a diagnosis of pineal germinoma. Postoperatively he developed bilateral middle cerebral artery territory infarcts and became aphasic with left hemiparesis. Computed Tomography (CT) angiography revealed bilateral Moyamoya vasculopathy. Two months post-operatively he developed spontaneous left frontal lobe hemorrhage with intraventricular extension; emergent external ventricular drain inserted. The patient was discharged in a vegetative state.
        Conclusion: Management of both these conditions pose a therapeutic challenge as chemo-radiation therapy for germinoma holds a risk of potential worsening of neurologic deficits related to Moyamoya.

        Case Report Pages: 1 - 2

        Association of Multiple Sclerosis and Castleman Disease: A Case Report and Literature Review

        Maroua Melliti*, Malek Mansour, Amel Kacem, Ines Bedoui and Ridha Mrissa

        Castleman Disease (CD) is an uncommon lymphoid hyperplasia occurring in the mediastinal lymph nodes, and less frequently in the neck lymph nodes. Several factors, likewise Multiple Sclerosis (MS), are reported to be involved in the mechanism of each of the diseases.

        Volume 11, Issue 12 (2021)

          Case Report Pages: 1 - 2

          A Rare Complication after Anti SARS CoV-2 Vaccination: Septic Arthritis of the Sternoclavicular Joint, Mediastinitis and Pulmonary Embolism

          Claudio Marone*, Mariagiovanna Di Palo, Orazio Nannola, Barbara Flora Russo, Maurizio Sacco, Luisa Isabella Siniscalchi and Mariano Carafa

          Introduction: There is a lot of interest and spirited debate about the adverse effects of anti-SARS CoV2 vaccines in the global pandemic context of the SARS Co-V2 infection.

          Aim of the study: the purpose of this article is to demonstrate a link between vaccine inoculation and the development of some unusual clinical symptoms.

          Methods: We describe the case of a 21-year-old young woman who developed symptoms of fever, chest and limb discomfort in her left upper arm around 10 days after receiving her first dose of Moderna vaccine, necessitating a trip to the emergency room and hospitalization 14 days later. Septic arthritis of the left sternoclavicular joint, mediastinitis, deep vein thrombosis of the left upper limb, and pulmonary embolism were diagnosed as a result of the instrumental tests performed during the hospital stay, particularly the angio TC of the chest and left upper limb; the growth of Staphylococcus aureus on a blood culture. The patient receives bacterial and anticoagulant therapy and recovers clinically and radiologically, allowing him to be discharged 10 days following hospitalization.

          Results: Given the chronological sequence, the vaccination's causative role in the formation of the clinical picture is extremely likely in this case, but with a plausible non-specific mechanism including vaccine injection at the venular or arteriolar level and adherence to asepsis.

          Conclusion: Although cases of septic arthritis following vaccines have been reported in recent years for influenza and pneumococcal vaccines, as well as more recently for SARS CoV2 vaccines (in particular with involvement of the shoulder joint), the novelty of our finding stems from the fact that it would be the first case of septic arthritis with a sternoclavicular localization, which is unusual in and of itself.

          Case Series Pages: 1 - 8

          Pneumothorax and Pneumomediastinum in Patients with Restrictive Eating Disorders: A Case Series and Literature Review

          Allison Nitsch*, Mark Kearns, Ashlie Watters and Phil Mehler

          Background: The purposes of this case series was to identify clinical characteristics of patients with restrictive eating disorders who have experienced pneumothorax or pneumomediastinum and elucidate possible risk factors for the development of pneumothorax or pneumomediastinum in this patient population through literature review. The scope of the case series is limited to patients admitted for medical stabilization from severe restrictive Eating Disorders (EDs).

          Methods: We compiled a series of adult patients with severe EDs who were diagnosed with a pneumothorax or pneumomediastinum while admitted to the ACUTE Center for Eating Disorders at Denver Health between April 2016 and January 2021. Additionally, a series of adult patients who reported a history of pneumothorax on admission to the same institution, during the same time period, were identified and characteristics of their pneumothorax were obtained using outside records provided by the patient at time of their admission. A literature review of cases of pneumothorax and pneumomediastinum in patients with EDs was completed.

          Results: Twenty-five cases of pneumothorax were identified in patients with anorexia nervosa (AN) or avoidant/restrictive food intake disorder (ARFID), all of whom were below normal body weight, between cases at our institution and literature review. Additionally, 5 patients at our institution, and 21 patients with EDs from the literature with below normal body weight with spontaneous pneumomediastinum were identified.

          Conclusions and limitations: The relationship of spontaneous pneumomediastinum in patients with AN and ARFID and low body weights is well established and can be managed conservatively with good outcomes. It is currently unclear if the starved state, and the lung changes it induces in these patients increases patients’ risk for spontaneous pneumothorax. Patients with AN and ARFID may be at higher risk for iatrogenic pneumothorax with certain invasive procedures. There is direct connection between patients’ eating disorder and occurrence of traumatic pneumothorax. Patients at expected body weights, or in larger bodies with restrictive Eds, were not included in this study and therefore, their risk of pneumothorax and pneumomediastinum in relation to their eating disorder behaviours is unknown.

          Case Report Pages: 1 - 5

          Case Report on Assessment and Management of Major Depressive Disorder

          Maimoona Khan* and Rabia Siraj

          Client Z.I was 36 years old man with presenting complaints of sleep disturbance, difficulty in concentration, restlessness, fatigue, lack of interest in anything, suicidal ideation and history of suicide attempt. In Forma assessment; Siddique Shah Depression Inventory (SSDI), Suicidal Ideation Scale (SIS) were used and in informal assessment observations, clinical interview, mental status examination, Dysfunctional Thought Record chart (DTR) used for diagnosis. Client was diagnosed with major depression disorder. Management plan was devised based on cognitive behaviour therapy techniques such as identifying distortions, ABC model, distraction techniques, motivational interviewing and hope box/survival kit, moreover no harm contract, art therapy, social therapy were used. Total 14 sessions were conducted.

          Case Report Pages: 1 - 3

          Bone Marrow Edema Syndrome in the Ankle: Case Reports and Literature Review

          Ali Abdulrahman Younis*

          Bone Marrow Edema Syndrome (BMES) is a clinical syndrome of unknown etiology characterized by the acute onset of pain gradually worsening over several weeks to months. Radiographic changes occur, but laboratory studies are generally unremarkable. It can primarily affect the foot and ankle and should be considered in the differential diagnosis of patients with acute foot and ankle pain, particularly in middle age men, and women in the third trimester of pregnancy. I here present 2 case reports of BMES of the ankle. Appropriate conservative treatment resulted in resolution of symptoms. Bone marrow edema syndrome can present a diagnostic challenge, but awareness of the typical presenting features and investigation findings can makes the diagnosis more accessible.

          Volume 11, Issue 11 (2021)

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Citations: 1096

Journal of Clinical Case Reports received 1096 citations as per Google Scholar report

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